Steroidal and nonsteroidal anti-inflammatory agents. Effect on postsurgical inflammation and blood-aqueous humor barrier breakdown
D. R. Sanders and M. Kraff
Two hundred and eighty-three patients scheduled to undergo extracapsular
cataract extraction with intraocular lens implantation were randomized into
four treatment groups that received 1% topical indomethacin and 0.1%
topical dexamethasone sodium phosphate, either drug and the other drug's
placebo, or two placebos. Inflammation was assessed by clinical grading,
and the breakdown of the blood-aqueous barrier was evaluated by slit-lamp
anterior segment fluorophotometry. Patients who used either or both
anti-inflammatory agents had significantly less inflammation or
blood-aqueous barrier breakdown than did those who used neither agent.
Also, the use of both topical indomethacin and dexamethasone resulted in
less fluorescein leakage during the second postoperative week than did the
use of dexamethasone alone. Since this difference could not be detected by
clinical measurement, we believe that fluorophotometry is a more sensitive
quantitative measure. Clinical assessment of inflammation did correlate
with fluorophotometric measurements, as patients with clinically
unacceptable inflammation had 3.7 times more fluorescein leakage in the
surgically treated eye than did patients with clinically acceptable
inflammation.
